<!DOCTYPE html>
<html>
<meta charset="utf-8">
<head th:include="include :: header"></head>
<body class="gray-bg">
	<div class="wrapper wrapper-content ">
		<div class="row">
			<div class="col-sm-12">
				<div class="ibox float-e-margins">
					<div class="ibox-content">
						<form class="form-horizontal m-t" id="signupForm">
							<input id="userId" name="userId" type="hidden">
							<div class="form-group">
								<label class="col-sm-3 control-label"><span style="color: red;">*</span>姓名：</label>
								<div class="col-sm-8">
									<input id="name" name="name" class="form-control" type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><span style="color: red;">*</span>用户名：</label>
								<div class="col-sm-8">
									<input id="username" name="username" class="form-control"
										type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><span style="color: red;">*</span>身份证号码：</label>
								<div class="col-sm-8">
									<input id="idCardNumber" name="idCardNumber" class="form-control"
										   type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><span style="color: red;">*</span>性别：</label>
								<div class="col-sm-8">
									<select name="sex"  id="sex" class="form-control">
										<option value="1">男</option>
										<option value="2">女</option>
									</select>
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><span style="color: red;">*</span>手机号码：</label>
								<div class="col-sm-8">
									<input id="mobile" name="mobile" class="form-control"
										   type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><span style="color: red;">*</span>邮箱：</label>
								<div class="col-sm-8">
									<input id="email" name="email" class="form-control"
										type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">所属代理：</label>
								<div class="col-sm-8">
									<select name="parentAgentId" id="parentAgentId" class="form-control chosen-select">
										<option value="">请选择代理</option>
									</select>
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><span style="color: red;">*</span>所在地区：</label>
								<div class="col-sm-8">
									<select name="area2" id="area2" onChange="getAreaInfo(this.value,3);setArea(this.value,2,'areaId');" style="width:25%;" class="form-control col-sm-1" required>
									</select>
									<select name="area3" id="area3" onChange="getAreaInfo(this.value,4);setArea(this.value,3,'areaId');" style="display:none; width:30%;" class="form-control col-sm-1" required>
									</select>
									<select name="area4" id="area4" onChange="setArea(this.value,4,'areaId');"style="display:none; width:30%;" class="form-control col-sm-1" required>
									</select>
									<input type="hidden" name="proviceAreaId" id="proviceAreaId">
									<input type="hidden" name="cityAreaId" id="cityAreaId">
									<input type="hidden" name="qxAreaId" id="qxAreaId">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">详细地址：</label>
								<div class="col-sm-8">
									<input id="liveAddress" name="liveAddress" class="form-control" type="text">
								</div>
							</div>
							<div class="form-group">
								<div class="col-sm-10 col-sm-offset-5">
									<button type="submit" class="btn btn-primary">提交</button>
									<button type="button" onclick="closeIndex();" class="btn btn-danger">取消</button>
								</div>
							</div>
						</form>
					</div>
				</div>
			</div>
		</div>

	</div>
	<div th:include="include::footer"></div>
	<script type="text/javascript" src="/js/appjs/common/area/area.js"></script>
	<script type="text/javascript" src="/js/appjs/sys/staff/add.js"></script>
</body>
</html>
